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Cablegate: Burma: Responses to Avian and Pandemic Influenza

This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 04 RANGOON 001323

SIPDIS

STATE FOR EAP/MLS; PACOM FOR FPA; USDA FOR FAS, APHIS

E.O. 12958: N/A
TAGS: EAGR EAID PGOV PHUM PREL SENV SOCI TBIO BM
SUBJECT: BURMA: RESPONSES TO AVIAN AND PANDEMIC INFLUENZA

REF: A. STATE 209622
B. RANGOON 1275
C. RANGOON 1157
D. RANGOON 1036

1. Burma has made some strides in preparing for a potential
avian influenza (AI) pandemic, but much more needs to be
done. Our responses to questions in ref A follow:

PREPAREDNESS /COMMUNICATION

2. Does the government have a preparedness plan/strategy for
preventing avian flu from becoming a pandemic and containing
a pandemic once it occurs? If the country has a strategy,
how capable is it of implementing it? Please provide a copy
of the plan or the Internet address for the plan.

Response: The Ministry of Health established a task force to
formulate a "Contingency Plan for Preventing and Controlling
an Avian Influenza Epidemic in Myanmar" dated on December 31,
2004. The Plan of Action was published in January 2005.
Since then a National Pandemic Plan has been prepared by
various sub-committees and submitted to the National Health
Committee. The National Health Committee endorsed both the
National Influenza Pandemic Plan and the Plan of Action. The
Government of Burma (GOB) subsequently formed a
multi-sectoral National Steering Committee on Prevention,
Management, and Control of Avian Influenza with six
sub-committees.

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The capability of the GOB to implement their plan is
doubtful. According to the Minister of Health, the GOB will
attempt to fight AI to the best of its ability despite its
"meager resources" (ref B). The Ministry of Health is
cooperating closely with the WHO on AI issues, which gives
hope that the GOB will receive at least some sound guidance.
The sudden move of the government from Rangoon to a new
administrative capital in Pyinmana comes at a season when
Burma is most vulnerable to incoming migratory birds. The
ongoing move could divert the attention of the Ministry of
Health and other relevant ministries from AI outbreaks and
reduce their ability to respond rapidly. Post has obtained a
copy of the GOB plan and is translating it into English; we
will forward it to OES and EAP upon completion.

3. How truthful will the government be in reporting the scope
of any disease outbreak among people? Among animals? What
incentives could be offered that would likely result in more
transparency?

Response: According to the Minister of Health, his ministry
is committed to transparency and has shared details of
several recent suspect outbreaks that it investigated and
concluded they were caused by other infectious diseases, not
AI. The FAO in Burma has informed us on several occasions
that they are not aware of any outbreaks of AI among animals
in Burma to date and report good cooperation from the
Livestock and Fisheries Ministry. However, the culture
discourages forwarding bad news, so individuals outside of
the capital might decide to suppress reports of suspicious
outbreaks. The Minister of Health has specifically asked us
whether the United States could provide rapid laboratory test
kits for use in suspected outbreaks of AI among humans (ref
B). Since it is in our interests to contain an outbreak of
AI wherever it occurs, it will be helpful to explore ways the
U.S. or international agencies could meet this request.

4. Where does preparing for an avian flu human pandemic rank
among government priorities? Who and what would most
influence the country to give the issue a higher priority?
Who is the key "go-to" person, office, or department (i.e.
Minister for Health, Prime Minister, etc.) for USG officials
to engage on this issue?

Response: In recent weeks, the GOB appears to be paying more
attention to AI issues and has disseminated more media
reports to raise awareness among the public. However,
relocating the capital and other command and control
operations is the top priority now and could distract senior
officials' attention away from AI. Burma's neighbors
probably have the most influence in getting the GOB to give
AI a higher priority, especially China and the ASEAN. The
Minister of Health is the best person in the GOB to contact
on AI issues. Absent reliable contacts with GOB officials,
our key interlocutors on this issue remain the WHO and the
FAO.

5. Have national laws been reviewed to ensure that they are
consistent with the international health regulations and do
not pose barriers to avian influenza detection, reporting,
containment, or response?

Response: We are not aware that any national laws have been
reviewed in light of current AI threats. However, the GOB
relies heavily on guidance from the WHO on AI issues and has
incorporated WHO guidelines into their national plan for
combating AI.

6. Is the host country already working with international
organizations or other countries on the avian flu issue? Are
government leaders likely to ask for assistance from the U.S.
or other countries? Would government leaders be receptive to
messages from U.S. leaders through a bilateral approach, at a
multilateral forum such as the UN (WHO, FAO, etc.) or APEC,
or through bilateral contacts by a third country? What would
the country want from the U.S. in return for its efforts?

Response: The GOB works closely with WHO, FAO, and regional
countries on AI issues. The Prime Minister recently attended
the Ayeyarwaddy-Chao Phraya-Mekong Economic Cooperation
Strategy (ACMECS) summit in Bangkok. He stated on national
television that the GOB will participate with regional
countries to fight AI and other diseases. The Minister of
Health has requested the international community, including
the U.S., to assist his ministry with rapid laboratory test
kits for suspected AI cases among humans. The GOB has
received assistance from Japan for testing suspected AI
outbreaks among animals. The Minister of Health said that if
someone could help him with rapid laboratory test kits he
would ask for nothing more (ref B).

7. Does the country currently administer annual flu shots?
If not, might it consider doing so? What is the production
capability (i.e. how many doses of the annual trivalent flu
vaccine can the country make) for human influenza vaccines in
the country? Does the country produce influenza vaccine for
poultry and if so, how much? If the country is developing an
H5N1 vaccine, where is it in production and testing? Any
licensing issues? Is there a liability shield for foreign
makers/donors of vaccines? If not, any prospects of one
being enacted?

Response: The government does not administer annual flu shots
to the public or to its civil servants or military. Flu
vaccine is only available at two private clinics in Rangoon
in very limited amounts, for approximately US$ 25 per dose,
which is equal to the average monthly salary of a Burmese
civil servant. The country does not produce trivalent flu
vaccine nor is it developing H5N1 vaccine.

8. How well informed is the population about the avian flu
threat and about measures they should take to mitigate the
threat? What mechanisms are available for providing
additional information to the population, particularly in
rural areas and how effective are these measures?

Response: The population is not well informed about the
threat of AI and what they can do to mitigate it. The GOB
has been increasing its coverage recently about AI issues on
its officially-controlled radio, television, and print media.
Many people in Burma rely on foreign radio broadcasts (VOA,
RFA, BBC, DVB) for their news. This avenue offers an
excellent medium for increasing knowledge among rural
populations about what they can do to mitigate the threat of
AI.
SURVEILLANCE / DETECTION

9. How capable are the medical and agriculture sectors of
detecting a new strain of influenza among people or animals
respectively? How long might it take for cases to be
properly diagnosed, given other endemic diseases? Can
influenza viruses be subtyped in the country, if so by whom,
and if not, where are they sent? Does the country send
samples to a WHO/EU/US reference laboratory?
Response: The Livestock Breeding and Veterinary Department of
the Ministry of Livestock and Fisheries has some rapid
laboratory test kits for detecting new strains of influenza
among animals. The Ministry of Health lacks this capability
for humans, although it has assigned its Central Epidemiology
Unit as the focal point for surveillance. The WHO has
informed us that in-country laboratories do not meet
international standards. Influenza viruses cannot be
identified easily by subtype in the country, therefore
specimens are normally sent to Bangkok for analysis. In a
recent suspected outbreak of AI among humans, which turned
out to be Influenza A, the Ministry of Health cooperated
closely with the WHO, which transferred blood samples from
the victims to Bangkok within 24 hours of the samples being
collected. WHO is the primary reference laboratory for
samples collected in Burma.

10. What are the critical gaps that need to be filled in
order to enhance the country's disease detection and outbreak
response capabilities? What is the country's greatest need
in this area from the U.S. or international organizations?
Response:

-- The population, 75% of whom live in rural areas with
minimal access to information, needs to be better informed
about being alert to deaths among wild bird and domestic bird
populations and how to report such deaths;

-- The communication channels from grassroots areas to the
central government need to be improved for rapid transmission
of reports;

-- The Ministry of Health needs rapid laboratory test kits to
be able to quickly diagnose suspected cases among human
populations;

-- The country needs sufficient stockpiles of antiviral drugs
to administer to populations that may live in the area of an
outbreak.

RESPONSE / CONTAINMENT

11. Does the country have a stockpile of medications,
particularly of antivirals, and if so, how much? If some has
been ordered, how much and when is it expected?

Response: The Ministry of Health says it does not even have
sufficient stockpiles of antiviral drugs to provide
prophylaxis to its health personnel who are responsible to
care for AI victims, but claims it is in the process of
stockpiling 10,000 doses of Tamiflu. The WHO donated the
Tamiflu they currently have. The GOB has appealed to other
countries for donations of antivirals and believes that China
will provide some once it has established its own production
capacity. The GOB also counts on access to WHO's regional
stockpile of antivirals in the event of an AI outbreak in
Burma.

12. Does the country have a stockpile of pre-positioned
personal protective gear?

Response: The GOB has very limited stocks of personal
protective gear for use by field investigation teams and
health care providers in designated isolation wards and
medical facilities only.

13. What is the rapid response capacity for animal and human
outbreaks? Are guidelines in place for the culling and
vaccination of birds, disinfection of facilities, and
limitations on animal movements?
Response: The Ministry of Health and the Ministry of
Livestock and Fisheries have AI rapid response teams
reportedly on standby to respond to new suspected outbreaks
around the country (ref B). These teams were reportedly
activated several times in recent weeks. Their
investigations revealed other diseases, not AI. Rapid
response teams have also been formed at the international
airports in Rangoon and Mandalay to screen passengers and
triage suspect cases. According to the Ministry of Health,
personnel at border crossing points with China and Thailand
are conducting ongoing surveillance. We are awaiting
translation of the "Contingency Plan for Preventing and
Controlling an Avian Influenza Epidemic in Myanmar" before we
can comment on specific guidelines for culling, vaccinating,
disinfecting and curtailing animal movements. We believe the
GOB has established guidelines for three of the four areas,
excluding vaccination of birds.

14. How willing and capable is the government of imposing
quarantines and social distancing measures (closing schools,
public gatherings, mass transit)? Would its military enforce
quarantines?

Response: The authoritarian, military-dominated regime is
both willing and capable of imposing quarantines if it deems
such measures expedient. Recent events have revealed the
senior leadership to be unpredictable, yet able to suddenly
uproot its civil service and move them 240 miles north of
Rangoon.
VILLAROSA

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